A study published in JAMA Oncology has found that interventions to improve patient-centered communication was successful in patients with advanced cancer, but it failed to improve quality of life (QOL), patient-physician relation, or healthcare utilization toward the end of life.
To quantify the impact of patient-centered communication between an oncologist and a patient on the quality of care, patient’s quality of life (QOL), and the need for making informed decisions, a global interventional study was designed and conducted at centers across the United States and in Australia. The Values and Options in Cancer Care (VOICE) study evaluated the impact of 2 interventions on the outcomes listed above in patients with advanced cancer.
Participating oncologists, whose baseline communication patterns had been assessed, were randomized to receive individual communication training via patient instructors if they were in the intervention arm. Patients and their caregivers who were randomized to receive the intervention were provided an individualized coaching session with follow-up telephone calls. Participants were enrolled between August 2012 and June 2014, with follow-up till October 2015.
Patients enrolled in the trial were being treated for nonhematologic cancers (stage III or IV) and had a poorer prognosis. Inpatients and hospice patients were excluded. The trial enrolled a total of 265 patients who agreed to an audio recording of their office visits and a pre-visit and postvisit questionnaire. The following interventions were provided:
The training sessions focused on 4 main domains of patient-centered communication:
The primary outcome was a combination of patient-centered communication measured from audio recordings of the first visit after patient coaching or enrollment (control group). The trial also measured patient-physician relation, shared understanding of prognosis, QOL, and aggressive treatment and hospice use in the last 30 days of life as secondary outcomes.
The final analysis, which included data from 38 oncologists and 265 patients, found that the interventional strategy devised for this study resulted in clinically and statistically significant improvement in the primary physician-patient communication (adjusted intervention effect, 0.34; 95% CI, 0.06-0.62; P = .02). the authors write that paired communication training involving patients and oncologists achieves patient-centered care in advanced cancer by engaging patients in consultations, responding to their emotions, and providing information on prognosis and chosen treatments. Secondary outcomes, however, were not influenced by the intervention. Examining the impact on patient QOL, the authors explain that cancer patients report stable QOL during the entire course of disease, till the last few months.
Since the current intervention did not impact QOL, they discuss adjusting the timing of the intervention in future studies, hoping to impact QOL trajectories. The authors also suggest training office personnel to develop skillsets to coach patients to address logistical and methodological difficulties. Since healthcare utilization was the same between the 2 cohorts, the authors recommend addressing physician attributes and institutional norms in the context of aggressive interventions and hospice in patients with advanced cancer.
Epstein RM, Duberstein PR, Fenton JJ, et al. Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial [published online September 9, 2016]. JAMA Oncol. doi: 10.1001/jamaoncol.2016.4373.